{
  "abstract": "Background Gastric ulcers are uncommon in pediatric populations, with an incidence of 2–8% in children and an extremely rare occurrence in early infancy. 1 The primary etiologies include Helicobacter pylori infection and prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs).2 We present a rare case of a bleeding gastric ulcer in a 2.5-month-old infant with concurrent H. pylori infection, maternal aspirin/NSAID exposure during breastfeeding, and COVID-19 infection.3Case Presentation A 2.5-month-old male presented with severe pallor, recurrent hematemesis (post-breastfeeding), and melena for one week, despite maintaining normal weight gain. Hemoglobin was 3 g/dL, requiring transfusion. The infant’s mother had contracted COVID-19 one month earlier, recovered within 5 days, but continued aspirin and other NSAIDs for a month during breastfeeding. Clinical examination revealed severe pallor but was otherwise unremarkable. Stool testing showed WBCs and RBCs; stool culture was negative. Upper gastrointestinal endoscopy revealed a bleeding gastric ulcer on the greater curvature. Biopsy demonstrated chronic gastritis, and H. pylori antigen was positive. Five days into hospitalization, the infant tested positive for COVID-19.3Treatment included intravenous omeprazole, diet modification, fluids, and subsequent triple therapy (H. pylori eradication regimen: proton pump inhibitor, clarithromycin, and amoxicillin for 14 days). COVID-19 was managed symptomatically. Clinical recovery was achieved, with normalization of hemoglobin and resolution of bleeding. Seven-month follow-up confirmed complete recovery and negative H. pylori stool antigen.3Discussion This case is notable for:Unusual age of onset – gastric ulcers are extremely rare in infants under 3 months.1 3Atypical ulcer location – on the greater curvature, whereas most pediatric gastric ulcers occur on the lesser curvature.7Multiple potential risk factors – H. pylori infection, aspirin exposure via breast milk, low socioeconomic status, and concurrent COVID-19 infection.2 4–6H. pylori is a well-established cause of chronic gastritis and gastric ulceration, with increased prevalence in low-income regions and possible maternal–child transmission. Although most NSAIDs pose minimal risk to nursing infants, aspirin may be transmitted via breast milk in pharmacologically relevant amounts, particularly with chronic maternal use, potentially exacerbating gastric mucosal injury. The role of COVID-19 in ulcer pathogenesis remains unclear, though studies report a high prevalence of active ulcers among infected patients with gastrointestinal symptoms.4–6Conclusion Gastric ulceration, though rare in early infancy, should be considered in cases of upper gastrointestinal bleeding. This case underscores the importance of evaluating H. pylori infection even in very young infants and considering maternal medication history during breastfeeding. Early endoscopic diagnosis and targeted eradication therapy can result in complete recovery.Reference Sierra D, Wood M, Kolli S, et al. Pediatric gastritis, gastropathy, and peptic ulcer disease. Pediatr Rev 2018;39(11):542–549.Woolf A, Rose R. Gastric Ulcer. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, 2024.Martini N, Al haj Kaddour M, Baddoura M, Jarjanazi M, Mahmoud J. A case report of a gastric ulcer in a 2.5-month-old infant in Syria: Helicobacter pylori and Aspirin as possible causes. SAGE Open Medical Case Reports. 2024;12. doi:10.1177/2050313X241242932Roberts-Thomson IC. Rise and fall of peptic ulceration: a disease of civilization? J Gastroenterol Hepatol 2018;33(7):1321–1326.Bloor M and Paech M. Nonsteroidal anti-inflammatory drugs during pregnancy and the initiation of lactation. Anesth Analg 2013;116(5):1063–1075.Mauro A, De Grazia F, Lenti MV, et al. Upper gastrointestinal bleeding in COVID-19 inpatients: incidence and management in a multicenter experience from Northern Italy. Clin Res Hepatol Gastroenterol 2021;45(3):101521.Mezoff AG and Balistreri WF. Peptic ulcer disease in children. Pediatr Rev 1995;16(7):257–265.",
  "authors": [
    {
      "affiliations": [
        "Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic",
        "Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA",
        "Stemosis for Scientific Research, Damascus, Syrian Arab Republic"
      ],
      "name": "Nafiza Martini"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic",
        "Stemosis for Scientific Research, Damascus, Syrian Arab Republic"
      ],
      "name": "Maha Al Haj Kaddour"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic",
        "Stemosis for Scientific Research, Damascus, Syrian Arab Republic"
      ],
      "name": "Mouna Baddoura"
    },
    {
      "affiliations": [
        "Aleppo University Hospital, Aleppo, Syrian Arab Republic"
      ],
      "name": "Mulham Jarjanazi"
    },
    {
      "affiliations": [
        "Stemosis for Scientific Research, Damascus, Syrian Arab Republic",
        "Department of Pharmacology, Tartous University, Tartous, SYR"
      ],
      "name": "Samer Younes"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic",
        "Stemosis for Scientific Research, Damascus, Syrian Arab Republic",
        "Pediatric University Hospital, Damascus University, Damascus, Syrian Arab Republic"
      ],
      "name": "Jaber Mahmoud"
    }
  ],
  "title": "OC95 Gastric ulcer in a 2.5-month-old infant in Syria: possible role of helicobacter pylori and aspirin exposure",
  "uid": "d64f898d-faaf-5e8d-80b6-bc09c19e2317"
}